Normal Intima-media Thickness Research Articles

A Novel Peptide Elabela is Associated with Hypertension-Related Subclinical Atherosclerosis.

Elabela is a newly identified peptide which, alongside apelin, acts as an endogenous ligand that activates the angiotensin receptor-like 1 receptor. Previous studies have shown the association of elabela with hypertension, but information about the role of elabela in hypertension-related subclinical atherosclerosis is scarce. We aimed to determine the elabela levels in hypertensive patients and exploreits association with subclinical atherosclerosis. A total of 104 subjects with hypertension were included in the study. Elabela levels were measured using an enzyme-linked immunosorbent assay, by first extracting the peptide following the manufacturer's instructions. Subclinical atherosclerosis was assessed by measuring the carotid intima-media thickness (IMT) using ultrasound. Compared to stage 1, elabela levels decreased in stage 2 hypertension (0.23 [0.13, 0.45] ng/ml vs. 0.14 [0.09, 0.23] ng/ml; P = 0.000), and in the group with increased carotid IMT compared to normal IMT (0.24 [0.13, 0.38] ng/ml vs. 0.15 [0.10, 0.23] ng/ml; P = 0.005). Additionally, a linear correlation analysis showed that elabela had a significant negative correlation with systolic blood pressure (r = -0.340, P = 0.000) and carotid IMT (r = -0.213; P = 0.030). In multivariate analysis, lower elabela levels were associated with a higher cardiovascular risk group in this study (OR 5.0, 95% CI 1.8-13.5, P < 0.001). This study demonstrated for the first time that circulating elabela declined in a higher stage of hypertension and hypertensive patients with increased carotid IMT, implicating that elabela may be involved in the pathogenesis of hypertension-associated subclinical atherosclerosis.

Decreased Cathepsin-K Mirrors the Severity of Subclinical Atherosclerosis in Kidney Transplant Recipients

Background: In kidney transplantation (Ktx) recipients, cardiovascular (CV) disease remains the leading cause of death. Abnormal carotid intima-media thickness (IMT) represents a valid indicator of incipient atherosclerosis also in this setting. Cathepsin-K (CatK) is a cysteine protease involved in vascular remodelling, as well as in progressive atherosclerosis. In this study we evaluated clinical predictors of CatK in Ktx recipients, with a particular focus on its possible relationships with subclinical atherosclerosis. Methods: Circulating CatK was measured in 40 stable Ktx recipients together with several laboratory, clinical and echocardiography parameters. 30 healthy subjects and 30 hemodialysis (HD) patients served as controls for CatK values. Carotid IMT was measured in Ktx and these subjects were then categorized according to age-gender reference cut-offs of normal IMT. Results: CatK levels were similar in Ktx recipients and healthy subjects but significantly reduced as compared to HD (p = 0.0001). In Ktx, at multivariate analyses CatK was associated with the LV end-diastolic volume (LVEDVi) (β = 0.514; p = 0.05), Ktx vintage (β = –0.333; p = 0.05) and mean IMT (β = –0.545; p = 0.05); this latter robust inverse association was confirmed also in another multivariate model with IMT as the dependent variable. Logistic regression analyses confirmed the beneficial meaning of CatK increase towards subclinical atherosclerosis [Odds Ratio (OR) 0.761; 95% Confidence Interval (CI) 0.569–0.918, p = 0.04]. At Receiver Operating Characteristics (ROC) analyses, CatK held a remarkable discriminatory power in identifying Ktx patients with abnormally increased IMT [Area Under the Curve (AUC) 0.763; 95% CI 0.601–0.926; p = 0.001]). Conclusions: In Ktx recipients, reduced CatK levels reflect the time-dependent improvement in the uremic milieu, cardiac adaptations and, above all, the severity of subclinical atherosclerosis. CatK measurement in Ktx may therefore hold significance for improving early CV risk stratification.

10 A NOVEL PEPTIDE ELABELA IS ASSOCIATED WITH HYPERTENSION-RELATED SUBCLINICAL ATHEROSCLEROSIS

Background: Elabela is a newly identified peptide which, alongside apelin, acts as an endogenous ligand that activates the angiotensin receptor-like 1 receptor (APJ). Previous clinical studies have shown the association of elabela with hypertension, but information about the role of elabela in hypertension-related atherosclerosis is scarce. Objectives: To determine the association between plasma elabela peptide levels and subclinical atherosclerosis in the hypertensive population. Methods: A total of 104 subjects with hypertension were included in a cross-sectional study. Plasma elabela levels were measured using enzyme-linked immunosorbent assay (ELISA) by extracting the peptide following the manufacturer's instructions. The subclinical atherosclerosis parameter was assessed by measuring the carotid intima-media thickness (IMT) using ultrasound. Results: Compared to stage 1, elabela levels decreased in stage 2 of the hypertension group (0.14 [0.09, 0.23] ng/ml vs. 0.23 [0.13, 0.45] ng/ml; P = 0.000), and in the group with increased carotid IMT compared to normal IMT (0.15 [0.10, 0.23] ng/ml vs. 0.24 [0.13, 0.38] ng/ml; P = 0.005). Additionally, a linear correlation analysis showed that elabela had a significant negative correlation with systolic blood pressure (r = -0.340, P = 0.000) and carotid IMT (r = -0.213; P = 0.030). In multivariate analysis, decreased elabela levels (cut-off 0.155 ng/ml) were associated with the higher cardiovascular risk group in this study (OR 5.0, 95% CI 1.8-13.5, P &lt; 0.001). Conclusion: This study is the first to demonstrate the association of circulating elabela with carotid IMT in hypertensive patients, implicating that elabela is involved in the pathogenesis of hypertension-related subclinical atherosclerosis. Reduced elabela levels were also associated with increased cardiovascular risk.

Lower Plasma Albumin, Higher White Blood Cell Count and High-Sensitivity C-Reactive Protein are Associated with Femoral Artery Intima-Media Thickness Among Newly Diagnosed Patients with Type 2 Diabetes Mellitus.

IntroductionLow albumin levels, high levels of high-sensitivity C-reactive protein (hs-CRP), and high white blood cell count were risk factors for changes in arterial intima-media thickness (IMT). Femoral artery IMT damages were one of the common peripheral artery type 2 diabetes. This study was conducted to determine the association between femoral artery IMT and plasma albumin, hs-CRP levels, and white blood cell count in newly diagnosed patients with type 2 diabetes mellitus (nT2D).Materials and MethodsFrom January 2015 to May 2020, 306 patients with nT2D were recruited for this cross-sectional descriptive study at Vietnam’s National Endocrinology Hospital. We measured IMT by Doppler ultrasound.ResultsThere was a statistically significant difference in albumin, hs-CRP levels, hs-CRP-to-albumin ratio, and white blood cell counts between three different IMT groups namely normal IMT, thick IMT, and atherosclerosis (p = 0.003, p = 0.001, p = 0.001 and p = 0.049, respectively). In the multivariate linear regression analysis, white blood cell count, and hs-CRP levels showed a significantly positive correlation to IMT (standardized B and p of 0.17, 0.015 and 0.163, 0.024, respectively), but albumin levels were a significantly negative correlation to IMT (standardized B = –0.151, p = 0.029). The multivariate logistic regression analysis showed that albumin (OR = 0.79, 95% CI 0.65–0.90, p = 0.018), hs-CRP (OR = 1.09, 95% CI 1.01–1.18, p = 0.026), and white blood cell count (OR = 1.36, 95% CI 1.03–1.81, p = 0.033) had correlation to atherosclerosis of femoral artery.ConclusionReduced plasma albumin, elevated hs-CRP, and white blood cell count associated with IMT increased the odds for atherosclerosis of femoral artery among nT2D.

Monocyte to HDL Ratio in The Prediction of Carotid Artery Intima-Media Thickness

Aim: In this study, we aimed to determine whether an increased monocyte count to high-density lipoprotein (MHR) would predict increased carotid intima-media thickness (IMT). Material and Method: All consecutive subjects presenting to the cardiology outpatient clinic of our institute were enrolled in this cross-sectional study. Subjects with cardiovascular and inflammatory diseases were excluded. Subjects were divided into two groups according to carotid IMT: those with carotid IMT &amp;gt;0.9 mm (increased) and those with carotid IMT ≤0.9 mm (normal). The difference in MHR between the two groups was the primary outcome measure of the study.Results: The MHR of the subjects with increased IMT was significantly higher than that of subjects with normal IMT (16.7 ± 5.7 vs. 12.8 ± 5.5, p &amp;lt;0.001). Logistic regression analysis demonstrated that age (OR: 1.202, 95% CI: 1.126-1.284, p&amp;lt;0.001) and MHR (OR: 1.190, 95% CI: 1.097-1.291, p&amp;lt;0.001) were significant predictors for a carotid IMT of &amp;gt;0.9 mm. ROC curve analysis revealed an MHR value of 13.4 as a cut-off in the identification of subjects that had increased IMT, with a sensitivity of 72% and specificity of 60.7%.Conclusion: The inflammation marker MHR can be used as a simple and cost-effective marker to predict increased carotid IMT which is accepted as the indicator of subclinical atherosclerosis.

Development and Proof of Concept of a Low-Cost Ultrasound Training Model for Diagnosis of Giant Cell Arteritis Using 3D Printing.

Objectives: Currently, ultrasound (US) is widely used for the diagnosis of giant cell arteritis (GCA). Our aim was to develop a low-cost US training model for diagnosis of GCA of the temporal and axillary artery using a modern 3D printing system. Methods: We designed an US training model, which enables measurement of the intima-media thickness (IMT) of temporal and axillary arteries using Autodesk Fusion360. This model was printed using a modern 3D printer (Formlabs Form3) and embedded in ballistic gelatine. The ultrasound images including measurement of the IMT by ultrasound specialists in GCA were compared to ultrasound images in acute GCA and healthy subjects. Results: Our ultrasound training model of the axillary and temporal artery displayed a very similar ultrasound morphology compared to real US images and fulfilled the OMERACT ultrasound definitions of normal and pathological temporal and axillary arteries in GCA. The IMT measurements were in line with published cut-off values for normal and pathological IMT values in GCA and healthy individuals. When testing the models on blinded US specialists in GCA, they were identified correctly in all test rounds with an intra-class coefficient of 0.99. Conclusion: The production of low-cost ultrasound training models of normal and pathological temporal and axillary arteries in GCA, which fulfil the OMERACT ultrasound definitions and adhere to the published IMT cut-off values in GCA, is feasible. Ultrasound specialists identified each respective model correctly in every case.

Association between Gut Microbial Diversity and Carotid Intima-Media Thickness.

Background and Objectives: There is an increasing focus on the effect of the gut microbiome on developing atherosclerosis, but there is still no unified standpoint. We aimed to find associations between intestinal microbiome diversity and a marker of subclinical atherosclerosis, the carotid intima-media thickness (IMT). Materials and Methods: Recruited from the Hungarian Twin Registry, 108 monozygotic (MZ) twins (mean age 52.4 ± 14.1 years, 58% female) underwent a comprehensive carotid ultrasound examination (Samsung RS85). Of the 108 MZ twins, 14 pairs (mean age 65 ± 6.4 years, 71% female) discordant for carotid IMT were selected to undergo a stool sample collection. A special stool sampling container was mailed and received from each participant. After DNA extraction, library construction was performed specifically for the V3–V4 hypervariable region of microbial 16S rRNA. Next, the microbiome composition of the samples was determined using Kraken software. Two hypotheses were tested with the exact permutation test: (1) in the group with normal IMT, the Shannon index of the phyla is higher; and (2) the Firmicutes/Bacteroidetes ratio is greater in the group with high IMT values. Furthermore, the abundance of different bacterial strains present at higher and normal IMT was also explored. Statistical analysis was carried out using R software. Results: Increased Firmicutes/Bacteroidetes ratio was associated with increased IMT (mean Firmicutes/Bacteroidetes ratio of IMT > 0.9 and IMT < 0.9 groups: 2.299 and 1.436, respectively; p = 0.031). In the group with normal IMT values, a substantially higher fraction of Prevotellaceae was observed in contrast with subjects having subclinical atherosclerosis. However, there was no significant difference in the alpha diversity between the two groups. Conclusions: The determining role of individual genera and their proportions in the development and progression of atherosclerosis can be assumed. Further studies are needed to clarify if these findings can be used as potential therapeutic targets.

Is the intima-media thickness of temporal and axillary arteries influenced by cardiovascular risk?

To measure with US the intima-media thickness (IMT) of temporal (superficial, parietal and frontal branches) and axillary arteries in subjects without a diagnosis of GCA and/or PMR with different cardiovascular (CV) risk; and to assess the performance of previously proposed cut-off values for normal IMT. Subjects ≥ 50 years without a diagnosis of GCA or PMR were included. Bilateral US of the temporal arteries, including the frontal and parietal branches, and axillary arteries was performed by two sonographers using a 10-22 MHz and 6-18 MHz probe. The following previously proposed cut-offs were considered: superficial temporal artery: 0.42 mm; frontal branch: 0.34 mm; parietal branch: 0.29 mm; axillary artery: 1.0 mm. A total of 808 arteries in 101 subjects were evaluated; of these, 31 (30.7%) were classified as very high CV risk, seven (6.9%) as high, 34 (33.7%) as moderate and 29 (28.7%) as low risk. Subjects with very high or high risk showed higher IMT than those with moderate or low risk in the superficial temporal arteries [0.23 (s.d. 0.07) vs 0.20 (s.d. 0.04), P < 0.01] and in the axillary arteries [0.54 (s.d. 0.17) vs 0.48 (s.d. 0.10), P = 0.002] . The IMT was higher than the reference cut-off in 13/808 (1.6%) arteries, in ≥1 artery in 10/101 subjects (10.1%). Of these 10 subjects, 8 (80%) were classified as having very high or high risk. Our results suggest that CV risk might influence the US-determined IMT of the temporal and axillary arteries in subjects without GCA. Therefore, in patients with suspected GCA, particular attention should be paid when measuring the IMT in those patients with very high/high CV risk.

CAROTID DOPPLER AS A BIOMARKER TO DETERMINE STENOSIS IN ISCHEMIC STROKE AND MANAGEMENT OF ICU PATIENT

Atherosclerosis is common cause of cerebrovascular diseases. Carotid Doppler is tool to determine atherosclerotic risk in patients leading to stroke. Carotid sonography isa invasive procedure and is most commonly being used. Proper management of atherosclerotic plaque and thickness could be reducing morbidity and mortality.All those patients with stroke admitted to Medicare cardiac and general hospital will be included in the study. All those patients with stroke due to intracerebral hemorrhage will be excluded from the study .Consent form was filled by the relatives of patients. Carotid Doppler was carried out external, middle and internal carotid arteries. Performa and consent form was filled by patient/ attendant. Pre and post antiplatelet and antithrombotic therapy color Doppler was done.Out of a total of 25 patients with stroke admitted or attending the walk-in clinic of medicare cardiac 7 general hospital . Intima media thickness was increased in 25 (100%) above 0.1mm ,calcified plaques were found in 20 ( 90%) patients and stenosis was less than 40% in 19 patients and above 50% in 6 patients. Control shown to have normal intima media thickness 0.1-0.6 mm , no plaques or stenosis. Carotid Doppler is found to be most useful biomarker to determine stenosis in ischemic stroke and plaque morphology also to management of intensive care unit patient.

P694Evaluation of preclinical atherosclerosis in chronic myeloid patients continuously treated with tyrosine kinase inhibitors

Abstract In tyrosine kinase inhibitors (TKIs) era chronic myeloid leukemia (CML) became from fatal to well controlled chronic disease. Meanwhile it seems that some TKIs may have cardiovascular (CV) effects. The aim of the study was to assess signs of preclinical atherosclerosis (PA) on different TKIs in CML patients (pts). Patients and method In our study 126pts with CML obtained TKIs as any line at least 6mos were included. Males were 56 (44,5%). The median age was 52 (20–76)yrs. Pts with previous history of atherosclerotic CV events were excluded. There were 115 (91%), 61 (48%), 48 (38%), 12 (11%) pts ever obtained Imatinib (IMA), Nilotinib (NILO), Dasatinib (DASA) or Bosutinib (BOSU) with median treatment duration 22mos, 14mos, 16mos and 15,5mos, respectively. Median time since the first TKI was 48 mos. There are 79, 46, 12 pts obtained 2, 3 or 4 TKIs. To assess PA ankle-brachial index (ABI) and intima media thickness (IMT) were measured. To evaluate ABI Vascular Screening System VaSera VS-1500 was used. Normal values for ABI and IMT were &gt;0,9 and ≤1,1. Results ABI was abnormally low in 14/108 (13%) evaluable pts. Previous TKIs of IMA, NILO, DASA and BOSU were in 12 (86%) and 87 (93%), 9 (64%) and 41 (43%), 5 (35%) and 29 (31%), 1 (7%) and 9 (10%) pts with or w/t low ABI. All NILO its were pretreated with IMA. Only 2 pts previously obtained other TKIs. Median time on NILO was 23 mos and 15mos in pts with or w/t abnormal ABI, respectively. Median age for pts with or w/t low ABI was 53 and 52 yrs. The proportion of male pts were lower in abnormal vs normal ABI group – 29% and 44%. In NILO group 2 pts were male and median age for all pts was 51yrs. IMT was evaluable in 86 pts. The median value of IMT was 0,8mm for all pts. It was abnormal in 12 (14%) pts with median thickness 1,3mm. All pts previously ever obtained IMA. NILO, DASA and BOSU were exposed in 5 (42%) and 33 (46%), 5 (42%) and 23 (31%), 1 (8%) and 7 (10%) pts with or w/t IMT abnormalities. The proportion of males was 4 (33%) and 34 (46%) among pts with or w/t abnormal IMT. Pts with high vs normal IMT were older with median age 64 vs 44yrs. TKIs2 were ever obtained in 13/14 (93%) and 11/12 (92%)pts with abnormal ABI and IMT&lt; respectively. Both ABI and IMT were abnormal only in 4 pts. Heart SCORE was high and very high only in 18/80 (22,5%) pts. Median age for low vs high risk pts were much lower (40 vs 52yrs). There were no differences between treatment groups according to SCORE distribution. Overall 9/50 (18%) and 3/32 (9%), 5/38 (13%) and 3/28 (11%)pts on NILO and DASA, had abnormal ABI and IMT. Conclusion CML pts heavily pretreated with different TKIs were included In the study. The most pts with abnormal ABI and IMT have ever been obtaining TKIs2. Pts with NILO more frequently experienced low ABI. There were not significant differences among TKIs groups regarding heart SCORE or IMT. It seems that extended PA is low on TKIs including NILO in CML pts w/t previous SVEs. Acknowledgement/Funding Funded from government assignment

Study of the Inflammatory Mechanisms in Hyperhomocysteinemia on Large-Artery Atherosclerosis Based on Hypersensitive C-Reactive Protein—A Study from Southern China

To study the inflammatory mechanism of hyperhomocysteinemia on large-artery atherosclerosis based on hypersensitive C-reactive protein in patients. In all, 153 inpatients and 1357 physical examinees were selected. The levels of homocysteine were compared between the carotid/intracranial artery stenosis group and the nonstenosis group, between the carotid artery unstable plaque group and the nonplaque group, and between the intima-media thickness (IMT) greater than or equal to 1 group and the normal IMT group. The hypersensitive C-reactive protein levels were compared between the lacunar infarction (LI) group and the nonstroke control group and between the unstable plaque group and the nonplaque group. Homocysteine level was significantly higher in the carotid/intracranial artery stenosis group than in the nonstenosis group, in the LI group than in the inpatient nonstroke group, and in the IMT greater than or equal to 1 group than in the normal IMT group. The hypersensitive C-reactive protein level was significantly higher in the LI group than in the nonstroke group and in the unstable plaque group than in the nonplaque group. Hyperhomocysteinemia may aggravate the development of IMT, carotid atherosclerotic plaque instability, and carotid/intracranial artery stenosis by increasing inflammation, ultimately leading to the occurrence of LI. Hyperhomocysteinemia-induced inflammation mechanism warrants further study.

Gene expression analysis of vascular pathophysiology related to anti-TNF treatment in rheumatoid arthritis

ObjectivesImpaired vascular pathophysiology and increased cardiovascular (CV) mortality are associated with rheumatoid arthritis (RA). To date, no genomic analysis of RA- and RA treatment-related vascular pathophysiology has been published. In this pilot study, we performed gene expression profiling in association with vascular pathophysiology in RA patients.MethodsSixteen and 19 biologic-naïve RA patients were included in study 1 and study 2, respectively. In study 1, genetic signatures determined by microarray were related to flow-mediated vasodilation (FMD), pulse-wave velocity (PWV), and common carotid intima-media thickness (IMT) of patients. In study 2, clinical response (cR) vs non-response (cNR) to 1-year etanercept (ETN) or certolizumab pegol (CZP) treatment, as well as “vascular” response (vR) vs non-response (vNR) to biologics, were also associated with genomic profiles. Multiple testing could not be performed due to the relatively small number of patients; therefore, our pilot study may lack power.ResultsIn study 1, multiple genes were up- or downregulated in patients with abnormal vs normal FMD, IMT, and PWV. In study 2, there were 13 cR and 6 cNR anti-tumor necrosis factor (TNF)-treated patients. In addition, 10, 9, and 8 patients were FMD-20%, IMT-20%, and PWV-20% responders. Again, vascular responder status was associated with changes of the expression of various genes. The highest number of genes showing significant enrichment were involved in positive regulation of immune effector process, regulation of glucose transport, and Golgi vesicle budding.ConclusionDifferential expression of multiple genetic profiles may be associated with vascular pathophysiology associated with RA. Moreover, distinct genetic signatures may also be associated with clinical and vascular responses to 1-year anti-TNF treatment.

Carotid Intima–Media Roughness and Elasticity in Hypertensive Patients With Normal Carotid Intima‐Media Thickness

ObjectivesTo investigate carotid intima‐media roughness (IMR) in hypertensive patients with normal carotid intima‐media thickness (IMT) using automatic identification software and the correlation between carotid IMR and risk factors.MethodsThis case‐control study comprised 61 hypertensive patients with normal carotid IMT and 51 control participants. Carotid IMR, carotid IMT, pulsed wave velocity (PWV), stiffness (β), and arterial compliance were determined by carotid ultrasound and image postprocessing using an automatic identification program and echo‐tracking analysis software.ResultsCarotid IMR, mean carotid IMT, maximum carotid IMT, β, and PWV in the hypertension group were higher than those in the control group (58.24 versus 34.61 μm, 641.17 versus 576.48 μm, 746.82 versus 640.55 μm, 9.42 versus 7.35, and 7.10 versus 5.86 m/s, respectively; P < .05), and arterial compliance was lower than that in the control group (0.70 versus 0.95 mm2/kPa; P < .05). Intima‐media roughness was correlated with maximum IMT, mean IMT, PWV, β, age, diagnosis of hypertension for greater than 1 year, and pulse pressure. Multivariate logistic regression showed that age, diagnosis of hypertension for greater than 1 year, and pulse pressure were influential factors for IMR in hypertensive patients, with odds ratios of 6.719 (95% confidence interval, 1.658–27.221; P = .008), 4.726 (95% confidence interval, 1.174–19.022; P = .029), and 3.998 (95% confidence interval, 1.033–15.466; P = .045), respectively.ConclusionsCarotid IMR and the elasticity index have important clinical importance in evaluating the risk of early atherosclerosis in hypertensive populations.

Lack of Correlation of Carotid Intima-Media Index and Peripheral Artery Disease

Increased carotid intima-media thickness (IMT) measurement is usually seen as a surrogate marker of peripheral artery disease (PAD) but there is scarce cumulated evidence to support this view. To evaluateprevalence of increased IMT among patients with symptomatic PAD as well as the frequency of some cardiovascular risk factors in these patients. They were recruited 230 patients with diagnosis of medium peripheral artery disease in the Vascular Surgery Service outpatient's office. Serum cystatin C, homocysteine, and lipoprotein (a) were measured. GFR was estimated using the CKD-EPI equation and the Larsson one from cystatin C. The global prevalence of increased IMT was 16.5% (n = 38, 95% CI 12.3-21.9). In all the frequency of hyperlipoproteinemia (a) was 34.2% (95% CI 28.4-40.5%). The global prevalence of hyperhomocysteinemia was 61.5% (95% CI 54.6-68.1%) and the proportion of patients with high cystatin C levels was 38.5% (95% CI 32.1-42.5). The prevalence of stage III chronic kidney disease or higher by CKD-EPI formula was much lesser (13.6%, 95% CI 9.7-18.7) as was the frequency obtained by the Larsson equation (28.7%, 95% CI 23.2-34.9). No differences were found between groups. Increased IMT is not common among PAD patients. Hyperlipoproteinemia (a) and hyperhomocysteinemia are very frequent in these patients. High serum cystatin levels are also very prevalent but reduced GFR is not so frequent. There were no differences in the prevalence of the studied cardiovascular risk factors between those patients with increased IMT and those ones with normal IMT.

Prognostic role of carotid intima-media thickness in off-pump coronary artery bypass surgery

Carotid intima-media thickness (IMT) is a well-known predictor of adverse outcomes in the ischemic heart disease patients; however, evidence is lacking in patients undergoing off-pump coronary artery bypass surgery (OPCAB). Data from 407 patients who underwent OPCAB between April 2013 and August 2016 were retrospectively reviewed. A composite of cardiovascular morbidity endpoints was defined as the presence of stroke, acute myocardial infarction, new cardiac arrhythmia (newly developed atrial fibrillation, atrial flutter, or atrioventricular block), cardiovascular death, or cerebrovascular death within 30 days after surgery. Increased carotid IMT was defined as ≥0.9 mm on one or both sides. The incidence of a composite of cardiovascular morbidity endpoints was 24.0% in the normal IMT group (n = 221) and 34.4% in the increased IMT group (n = 186) (p = 0.021). Multivariable analysis revealed increased IMT (odds ratio 1.719, 95% confidence interval 1.108 to 2.666, p = 0.016) and preoperative renal replacement therapy (odds ratio 4.264, 95% confidence interval 1.679 to 10.829, p = 0.002) as independent predictors of a composite of cardiovascular morbidity endpoints. In patients undergoing OPCAB, preoperative assessment of carotid IMT may help predicting the development of a postoperative composite of cardiovascular morbidity endpoints.

Evaluation of Vascular Remodeling in Carotid Atherosclerosis Among Type 2 Diabetes Mellitus Patients Using High-Frequency Ultrasonography Combined with Serum Resistin.

Diabetes remains a long standing public health issue among the Chinese population, with an incidence of up to 11.6%, of which type 2 diabetes mellitus (T2DM) accounts for 85%-95%. During this study, we aimed to elucidate the value of high-frequency ultrasonography (HFUS) combined with serum resistin on vascular remodeling (VR) in carotid atherosclerosis (CA) among patients suffering from T2DM. A total of 432 T2DM were recruited and assigned into the short T2DM duration group (<5 years), middle T2DM duration group (5~10 years) and long T2DM duration group (>10 years), while another 172 healthy cases were recruited as the control group. The intima-media thickness (IMT) as well as plaque score, detection rate and type were detected by the HFUS. The respective blood pressure readings were measured and pulse pressure was calculated accordingly. The serum resistin level, remodeling incidence and type, levels of total cholesterol (TC), fasting blood glucose (FBG), low-density lipoprotein cholesterol (LDL-C), high-density liproprotein cholesterol (HDL-C), and triglyceride (TG) were measured. The correlation between IMT, the plaque detection rate and blood pressure were analyzed. A receiver operating characteristic (ROC) curve was constructed in order to evaluate the impact of VR in CA on T2DM patients who were solely using HFUS and serum resistin respectively, as well as a combination of HFUS with serum resistin. As In comparison with the control group, the short, middle and long T2DM duration groups all displayed increased IMT, plaque score and detection rate, serum resistin level and VR incidence, especially for the long T2DM duration group. Levels of TC, TG, FBG and LDL-C were much higher while HDL-C was lower among patients with T2DM than those in the control group. A positive correlation was detected between the disease course and IMT. The detection rate of plaque with thickening IMT exhibited upregulated levels when compared to those with normal IMT. The HFUS, serum resistin and HFUS combined with serum resistin respective areas under the ROC curve were 0.873, 0.867 and 0.923, respectively, suggesting that the combination of HFUS and serum resistin was superior to that of individual HFUS or individual serum resistin in regard to the impact of VR in CA on T2DM patients. The results of this study revealed that the combination of HFUS and serum resistin was superior to individual HFUS or individual serum resistin in relation to its ability to evaluate the impact of VR in CA in patients with T2DM.

MACRO- AND MICROCIRCULATORY ABNORMALITIES OF VASCULAR WALL IN HYPERTENSIVE PATIENTS

Objective: To study arterial wall elasticity and stiffness in hypertensive's patients with moderate and high cardiovascular risk not receiving antihypertensive treatment. Design and method: The study included 41 hypertensive's patients (16 male and 27 female) with mean age of 61.1 ± 10.7 years, systolic, diastolic blood pressure (162.7 ± 20.8 mm Hg, 98.6 ± 11.2 mm Hg), hypertension duration 9.3 ± 7.2 years. Obesity was found in 32% of participants, 21% of patients were smokers. Carotid Doppler ultrasound study with intima-media thickness (IMT) measurement (using Aloka SSD 2000 ultrasound system) and photoplethysmography with augmentation index (AI), stiffness index (SI), delay in time between early and late systolic waves (dTPP), vascular age (VA) and stress index (SI) scores assessment (using Angioscan Professional system, Russia, 2015) were performed on all patients. Statistical analysis was done using Statistica 10.0 software. Results: There were 3 groups of patients: I (N = 14) with normal IMT (<0.9 mm) and no carotid atherosclerotic plaque present, II (N = 13) with increased IMT (>0.9 mm) and no plaques, and III (N = 14) with carotid atherosclerotic plaques (average number 2.0 ± 1.6 with the mean % narrowing of 32.4 ± 12.6). There were no differences in age, hypertension grade, obesity and smoking prevalence between the groups. With the increase in carotid atherosclerosis, a significant rise in AI was seen (−1.3 ± 19.7% in group I, 10.5 ± 12.7% in group II and 18.6 ± 13.8% in group III; p < 0.05), whereas dTPP was significantly lower in group III than in groups II and I (90.5 ± 30.7 vs 89.2 ± 17.2 ms vs 96.5 ± 29.3 ms, respectively; p < 0,05 between groups I and III). Significant difference in SI was found only between groups I and II (7.4 ± 1.07 m/s vs 8.2 ± 0.88 m/s, respectively; p < 0.05), while this parameter was 7.6 ± 1.09 m/s in group III. Patients from groups I, II, and III demonstrated a significant elevation of VA (44.7 ± 14.9 vs 58.3 ± 7.4 vs 63.5 ± 12.9 years, respectively; p < 0.05) and SI (3.1 ± 1.2 vs 3.5 ± 1.04 vs 3.9 ± 0.95, respectively; p < 0.05). A correlation between VA and carotid diameter (R = –0.7; p < 0.05), AI and the number of atherosclerotic plaques (R = 0.73; p < 0.05) was revealed in hypertensive's. Conclusions: Carotid atherosclerosis in hypertensive's is associated with microcirculatory abnormalities and increased vascular age and stress index scores.

Evaluation of carotid artery elasticity in patients with uremia by echo tracking.

The purpose of this study was to compare the carotid artery wall elasticity between patients with uremia and controls using echo tracking (ET). Ninety-three patients with uremia and 35 control subjects (Group A) were enrolled in this study. In the ET mode, the carotid artery elasticity parameters including stiffness index (β), pressure-strain elasticity modulus (EP), arterial compliance (AC), and one-point pulse wave velocity (PWVβ) were measured, and carotid intima-media thickness (IMT) was measured with B-mode ultrasonography. The patients were classified into three groups: Group B (normal IMT), Group C (thickened IMT), and Group D (one single atheroma plaque). β, EP, and PWVβ were significantly higher in Group B, C, and D (especially in group D) than those of the control group (P<0.05), and there were significant differences between Group A and Group B, while AC was lower than in controls, but there were no statistically significant differences among the four groups. ET is a noninvasive method that can demonstrate a loss in carotid artery elasticity in uremia patients with normal IMT.

Incremental predictive value of carotid arterial strain in patients with stroke.

Although increased carotid intima-media thickness (IMT) is a well-known risk factor for stroke, carotid IMT alone is not sufficient for risk stratification. The assessment of arterial properties using velocity vector imaging (VVI) represents a new method for quantifying structural changes. We sought to investigate the characteristics and the clinical value of carotid arterial mechanics using VVI in patients with stroke. Fifty male patients (55 ± 5years) with stroke, 30 healthy age-matched volunteers (54 ± 8years), and 30 healthy young male volunteers (29 ± 5years) were evaluated. The peak circumferential strain, strain rate, and the standard deviation of the time to peak strain and strain rate, representing the synchronicity of the arterial expansion, were analyzed using VVI of the left common carotid artery. The circumferential strain and strain rate significantly decreased with age, and patients with stroke showed the lowest degree of strain and strain rate compared with healthy age-matched volunteers. In addition, patients with stroke showed decreased strain and strain rate even in participants with a normal carotid IMT (< 0.8mm). Although carotid IMT did not improve the incremental predictive value of stroke over that of multiple clinical risk factors (diabetes mellitus, hypertension, coronary artery disease, smoking), adding carotid arterial strain and strain rate provided an incremental predictive value over both multiple risk factors and carotid IMT for stroke. Along with assessment of conventional risk factors, VVI analysis could provide improved risk stratification for stroke.

Circulating annexin A5 levels are associated with carotid intima-media thickness but not coronary plaque composition.

Annexin A5 (anxA5) is involved in processes which are crucial in atherogenesis. However, anxA5's relationship with atherosclerotic lesion extension and plaque composition in high-risk patients with type 2 diabetes remains unclear. Thus, we characterized the association between circulating anxA5 levels with atherosclerotic burden and coronary plaque composition in diabetes mellitus patients. Intima-media thickness was determined in 96 diabetes mellitus patients with stable coronary artery disease. Furthermore, intracoronary optical coherence tomography was performed in 106 lesions to determine plaque composition. AnxA5 plasma levels of patients with intima-media thickening were higher (3.49 ± 2.19 ng/mL) compared to patients with normal intima-media thickness (2.24 ± 1.67 ng/mL, p = 0.002). Furthermore, anxA5 was associated with intima-media thickening on univariable [odds ratio = 1.445 (1.106-1.889), p = 0.007] and multivariable [odds ratio = 1.643 (1.166-2.314), p = 0.005] logistic regression analysis when adjusted for multiple cardiovascular risk factors and biomarkers. Furthermore, receiver operating characteristic analysis demonstrated that anxA5 predicted intima-media thickening with low-moderate diagnostic efficiency [area under the curve = 0.700 (0.592-0.808)]. In contrast, there was no association between anxA5 levels and coronary plaque composition as assessed by optical coherence tomography including the presence of lipid, calcified, fibrous plaque or the minimal thickness of the fibrous cap overlying the necrotic lipid core ( p = ns). Circulating anxA5 levels are associated with carotid intima-media thickness but not coronary plaque composition in high-risk patients with diabetes mellitus.